| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
15,612 |
3,337 |
$413K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,779 |
2,761 |
$383K |
| D1120 |
Prophylaxis - child |
7,439 |
7,343 |
$260K |
| D0120 |
Periodic oral evaluation - established patient |
9,026 |
8,902 |
$249K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,394 |
1,218 |
$226K |
| D0272 |
Bitewings - two radiographic images |
6,836 |
6,740 |
$150K |
| D1110 |
Prophylaxis - adult |
2,758 |
2,708 |
$142K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
940 |
398 |
$131K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,310 |
827 |
$95K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,270 |
6,176 |
$88K |
| D0274 |
Bitewings - four radiographic images |
2,581 |
2,531 |
$82K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,567 |
2,472 |
$64K |
| D1206 |
Topical application of fluoride varnish |
3,898 |
3,843 |
$55K |
| D0330 |
Panoramic radiographic image |
884 |
871 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
2,933 |
2,820 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
885 |
864 |
$29K |
| D9248 |
|
230 |
221 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,513 |
1,356 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
186 |
121 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
461 |
445 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
85 |
85 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
61 |
33 |
$5K |
| D1330 |
|
48 |
47 |
$548.81 |
| D0603 |
|
13,032 |
12,857 |
$0.00 |
| D0602 |
|
85 |
83 |
$0.00 |
| D9986 |
|
14 |
12 |
$0.00 |